I have a favorite saying “it is what it is.” Simply put, certain things and situations are what they are and can’t be changed. Rhinoplasty is similar and I’d like to put down some of the basic principles about Rhinoplasty and revision Rhinoplasty that I believe can’t be changed. I should be very clear that this is my opinion.

1. You will never be made gorgeous by having a perfect nose….a natural looking one without obvious serious flaws is all that’s required.

2. Rhinoplasty is the most technically challenging Plastic and Cosmetic Surgery Procedure performed.

3. In the most skilled hands, the nose may be improved about 2 points on a scale from 1 to 10 with 10 being perfect. In other words a 6 can be an 8 (not a 9 or 10) and a 7 could become a 9 and so on.

4. There is no one right or wrong way to do a Rhinoplasty just the way that any particular Plastic and Cosmetic Surgeon can accommplish the desired results.

5. Basically, an open Rhinoplasty should be considered when the nasal tip is very wide, very crooked, has grafts from previous Rhinoplasty or has been over-resected and has obvious loss of the normal tip cartilages.

6. A closed Rhinoplasty should be considered in all other scenarios and because this Rhinoplasty procedure takes less surgical time, has quicker healing and is less invasive, one should not opt for an Open Rhinoplasty unless they have one of the conditions mentioned above.

7. Things can be used to shape and or build up portions of the nose and these grafts, struts etc all have advantages and disadvantages…see more below.

8. Best material to use on the nasal tip is your own ear cartilage. It’s soft enough for the tip area, won’t dissolve unevenly like bone or rib cartilage. Septal cartilage is a bit too hard for this area and man made grafts like medpore and gortex may get infected for no obvious reason years later and extrude from the nose.

9. For the bridge of the nose….I like silastic straight grafts without the L configuration. There is little chance for infection and extrusion along the bridge unlike in the tip area. Rib grafts, ear cartilage, septal cartilage, irradiated cartilage and bone all have a nasty habit of dissolving irregularly some years later. Medpore or gortex is an option here as well but like the tip area may become infected years later for no apparent reason, which in my opinion makes them less desireable.

10. Rhinoplasty should not be done any sooner than 6-12 month intervals as this may result in permanent damage to the nasal skin.

There you have it…the 10 rules of Rhinoplasty…by Dr. Francis R Palmer, III